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PubMed This is a summary of 21 peer-reviewed journal articles Updated
Infectious Disease

Recognizing the Warning Signs of TB

At a Glance

Tuberculosis (TB) symptoms depend on whether the infection is latent or active. Latent TB has no symptoms and is not contagious. Active pulmonary TB typically causes a persistent cough lasting over three weeks, heavy night sweats, fever, and unexplained weight loss. Weakened immunity can trigger latent TB to become active.

Understanding the symptoms of tuberculosis (TB) is essential for getting the right care at the right time. Because TB bacteria grow slowly, symptoms often appear gradually, sometimes taking months to become noticeable [1][2].

The Silence of Latent TB

It is critical to remember that Latent TB Infection (LTBI) has no symptoms [3]. If you have latent TB, you feel completely healthy, you are not contagious, and you do not have a cough or fever. The bacteria are dormant, or “sleeping,” held in check by your immune system.

Active Pulmonary TB: The Classic Signs

When TB bacteria become active in the lungs, it is called pulmonary TB. This is the most common form of the disease. The “classic” symptoms include:

  • Persistent Cough: A cough that lasts for three weeks or longer is the most common sign [4].
  • Hemoptysis: This is the medical term for coughing up blood or blood-tinged phlegm [1][5].
  • Chest Pain: Pain when breathing or coughing.
  • Constitutional Symptoms: These are “whole-body” symptoms that include:
    • Unexplained Weight Loss: Losing weight without trying [6].
    • Night Sweats: Heavy sweating during sleep that may soak your pajamas or sheets [7].
    • Fever and Chills: Often a low-grade fever that lingers [8].
    • Fatigue: Feeling extremely tired or weak.

Extrapulmonary TB (EPTB): Beyond the Lungs

TB doesn’t always stay in the lungs. In about 15-25% of active cases, it spreads to other parts of the body [9]. This is called Extrapulmonary TB (EPTB). While you may still have “whole-body” symptoms like fever or weight loss, other symptoms depend on where the bacteria are located:

  • Lymph Nodes (Tuberculous Lymphadenitis): The most common site for EPTB [9]. It usually presents as a painless swelling or “lump” in the neck (cervicofacial area) [10][11].
  • Pleura (Tuberculous Pleurisy): The lining around the lungs. Symptoms often include sharp chest pain that gets worse with a deep breath, and shortness of breath [11][12].
  • Brain/Spine (Meningitis): TB in the central nervous system is rare but very serious. It can cause severe headaches, neck stiffness, confusion, or back pain [11][13].
  • Kidneys or Bones: Can cause blood in the urine or joint pain.

A note on contagiousness for EPTB: It is a huge relief for many patients to learn that Extrapulmonary TB alone (without lung involvement) is generally not contagious. Unless you have an open sore or simultaneous pulmonary TB, you are unlikely to spread the infection to your family or friends if the disease is confined to your lymph nodes, spine, or other organs outside the lungs [9].

What Triggers the “Wake-Up” (Reactivation)?

In many people, the immune system keeps TB dormant for a lifetime. However, if the immune system is weakened, the bacteria can “wake up” and cause active disease. Common triggers include:

  • HIV/AIDS: This is the strongest known risk factor for TB reactivation because it specifically targets the T cells that keep TB contained [14][15].
  • High Blood Sugar (Diabetes): People with poorly controlled diabetes are at much higher risk for TB progression, likely because high blood sugar impairs the immune cells meant to fight the bacteria [16][17].
  • Immunosuppressive Medications: Certain drugs, like TNF-alpha inhibitors (used for rheumatoid arthritis or psoriasis) or long-term steroids, can break down the “walls” the body uses to trap TB [18][19].
  • Malnutrition or Aging: Anything that generally lowers the body’s ability to defend itself can increase the risk of reactivation [20][21].

Return to Understanding Your TB Diagnosis

Common questions in this guide

Does latent tuberculosis have symptoms?
No, latent TB infection has no symptoms. If you have latent TB, you feel completely healthy and are not contagious because your immune system is keeping the bacteria dormant.
What are the most common signs of active TB in the lungs?
The classic warning signs include a persistent cough lasting three weeks or longer, coughing up blood, chest pain, unexplained weight loss, lingering low-grade fever, chills, and drenching night sweats.
Can TB affect body parts other than the lungs?
Yes, in about 15-25% of active cases, TB spreads outside the lungs. This is called extrapulmonary TB and can affect the lymph nodes, the pleura (lining of the lungs), brain, spine, kidneys, or bones.
Is extrapulmonary TB contagious?
Generally, extrapulmonary TB without lung involvement is not contagious. You are unlikely to spread the infection to others if the disease is strictly confined to areas like your lymph nodes or spine.
What causes dormant TB to become active?
Latent TB can 'wake up' and become active if your immune system is weakened. Common triggers include HIV/AIDS, poorly controlled diabetes, immunosuppressive medications, malnutrition, and aging.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Given my symptoms, do you suspect the TB is in my lungs or in another part of my body?
  2. 2.Could my other health conditions, like diabetes or my current medications, be triggering this flare-up?
  3. 3.If I have latent TB, what specific 'red flag' symptoms should I watch for that would mean it is becoming active?
  4. 4.Does my chest X-ray show any signs of past or current TB activity?
  5. 5.What tests are needed to check for TB outside of the lungs, such as in my lymph nodes or pleura?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (21)
  1. 1

    Pulmonary aspergillosis presenting with recurrent haemoptysis.

    Betancourt BY, Garofoli AC, Sandhu JS, et al.

    BMJ case reports 2015; (2015()).

    PMID: 26153296
  2. 2

    Co-existing active pulmonary tuberculosis with aspergilloma in a diabetic patient: A rare case report.

    Soewondo W, Kusumaningrum CS, Hanafi M, et al.

    Radiology case reports 2022; (17(4)):1136-1142 doi:10.1016/j.radcr.2021.12.064.

    PMID: 35169416
  3. 3

    The definition of tuberculosis infection based on the spectrum of tuberculosis disease.

    Migliori GB, Ong CWM, Petrone L, et al.

    Breathe (Sheffield, England) 2021; (17(3)):210079 doi:10.1183/20734735.0079-2021.

    PMID: 35035549
  4. 4

    Anti-PD1 Antibody Treatment and the Development of Acute Pulmonary Tuberculosis.

    Fujita K, Terashima T, Mio T

    Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer 2016; (11(12)):2238-2240 doi:10.1016/j.jtho.2016.07.006.

    PMID: 27423391
  5. 5

    Chronic cavitary pulmonary aspergillosis as a sequela of pulmonary tuberculosis: A case report from Pakistan.

    Uzair A, Waseem M, Bhatti NI, et al.

    SAGE open medical case reports 2024; (12()):2050313X241251777 doi:10.1177/2050313X241251777.

    PMID: 38711680
  6. 6

    Rasmussen's Aneurysm: A Rare Case.

    Jadhav SS, Dhok A, Chaudhari SV, et al.

    Cureus 2022; (14(6)):e25740 doi:10.7759/cureus.25740.

    PMID: 35812556
  7. 7

    Pulmonary Tuberculosis With Saddle Pulmonary Embolism and Deep Vein Thrombosis: A Rare Case Report.

    Subahi EA, Alawad MJ, Abdelmahmuod EA, et al.

    Cureus 2021; (13(6)):e15958 doi:10.7759/cureus.15958.

    PMID: 34336453
  8. 8

    Primary intimal sarcoma of the left atrium presenting with constitutional symptoms.

    Marques Mendes E, Ferreira A, Felgueiras P, et al.

    Oxford medical case reports 2017; (2017(7)):omx031 doi:10.1093/omcr/omx031.

    PMID: 28694971
  9. 9

    Epidemiology and the diagnostic challenge of extra-pulmonary tuberculosis in a teaching hospital in Ethiopia.

    Arega B, Mersha A, Minda A, et al.

    PloS one 2020; (15(12)):e0243945 doi:10.1371/journal.pone.0243945.

    PMID: 33320897
  10. 10

    Burden of Mycobacterium tuberculosis and Associated Factors among Presumptive Extra pulmonary Tuberculosis Patients from Selected Health Facilities, Addis Ababa, Ethiopia.

    Alehegn E, Gebreyohanns A, Berhane B, et al.

    IJID regions 2023; (7()):199-205 doi:10.1016/j.ijregi.2023.03.007.

    PMID: 37114203
  11. 11

    The epidemiology of extrapulmonary tuberculosis in China: A large-scale multi-center observational study.

    Kang W, Yu J, Du J, et al.

    PloS one 2020; (15(8)):e0237753 doi:10.1371/journal.pone.0237753.

    PMID: 32822367
  12. 12

    Late diagnosis of disseminated tuberculosis: A case report.

    Rodriguez-Hidalgo LA, Ruíz Caballero DC, Vega-Fernandez A

    Medwave 2024; (24(7)):e2917 doi:10.5867/medwave.2024.07.2917.

    PMID: 39197166
  13. 13

    Assessment of Clinical, Histopathologic, and Radiologic Features in Extrapulmonary Tuberculosis Patients.

    Kharraz L, Bagheri A, Hatami F, et al.

    Tanaffos 2024; (23(4)):349-354.

    PMID: 41018938
  14. 14

    Incidence and predictors of extrapulmonary tuberculosis among people living with Human Immunodeficiency Virus in Addis Ababa, Ethiopia: A retrospective cohort study.

    Alemu A, Yesuf A, Gebrehanna E, et al.

    PloS one 2020; (15(5)):e0232426 doi:10.1371/journal.pone.0232426.

    PMID: 32374773
  15. 15

    Latent and Active Tuberculosis Infection Increase Immune Activation in Individuals Co-Infected with HIV.

    Sullivan ZA, Wong EB, Ndung'u T, et al.

    EBioMedicine 2015; (2(4)):334-340 doi:10.1016/j.ebiom.2015.03.005.

    PMID: 26114158
  16. 16

    Latent tuberculosis infection and non-infectious co-morbidities: Diabetes mellitus type 2, chronic kidney disease and rheumatoid arthritis.

    Ugarte-Gil C, Carrillo-Larco RM, Kirwan DE

    International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 2019; (80S()):S29-S31 doi:10.1016/j.ijid.2019.02.018.

    PMID: 30802622
  17. 17

    Diabetes mellitus and latent tuberculosis infection: an updated meta-analysis and systematic review.

    Zhou G, Guo X, Cai S, et al.

    BMC infectious diseases 2023; (23(1)):770 doi:10.1186/s12879-023-08775-y.

    PMID: 37940866
  18. 18

    Progression of tuberculosis among patients with rheumatic diseases - A systematic review and meta-analysis.

    Sundaram K, Vajravelu LK, Velayutham R, Mohan U

    The Indian journal of tuberculosis 2025; (72(2)):174-182 doi:10.1016/j.ijtb.2023.07.001.

    PMID: 40518207
  19. 19

    Safety in moderate-to-severe plaque psoriasis patients with latent tuberculosis treated with guselkumab and anti-tuberculosis treatments concomitantly: results from pooled phase 3 VOYAGE 1 & VOYAGE 2 trials.

    Puig L, Tsai TF, Bhutani T, et al.

    Journal of the European Academy of Dermatology and Venereology : JEADV 2020; (34(8)):1744-1749 doi:10.1111/jdv.16460.

    PMID: 32289190
  20. 20

    Prevalence of proximate risk factors of active tuberculosis in latent tuberculosis infection: A cross-sectional study from South India.

    Munisankar S, Rajamanickam A, Balasubramanian S, et al.

    Frontiers in public health 2022; (10()):1011388 doi:10.3389/fpubh.2022.1011388.

    PMID: 36276400
  21. 21

    Incidence and outcomes of adverse drug reactions to first-line anti-tuberculosis drugs and their effects on the quality of life: A multicenter prospective cohort study.

    Choi H, Park HA, Hyun IG, et al.

    Pharmacoepidemiology and drug safety 2022; (31(11)):1153-1163 doi:10.1002/pds.5513.

    PMID: 35909258

This page provides information on tuberculosis symptoms and risk factors for educational purposes only. If you are experiencing a persistent cough, night sweats, or unexplained weight loss, please consult a healthcare provider immediately.

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